Why CBT for Eating Disorders Is Often the Treatment of Choice
CBT-E, enhanced cognitive behavioral therapy, is an evidence-based treatment for eating disorders. It’s based on the premise that eating disorders share common features such as the restrict/binge cycle which perpetuates disordered eating and over-evaluation of weight and shape. The enhanced portion of CBT for eating disorders focuses on low self esteem, relationship problems and clinical perfectionism. The development and research of CBT-E is done by Dr. Christopher Fairburn et al at Oxford University in England. See more about where I received my CBT-E training here. During our first few sessions, I explain the CBT-E restrict/binge cycle, how restriction needs to be addressed with regular eating and how we manage external situations that exacerbate the eating disorder.
Is CBT Effective for Eating Disorders?
CBT focuses on the present, rather than past events and experiences. It is a therapy that helps us understand the connection between our thoughts, feelings and behaviors. When I use CBT in sessions with clients, I point out cognitive distortions, help them challenge and reframe thoughts — and confront negative core self beliefs. With eating disorders, we question the diet mindset, explore self beliefs about weight and shape, and change behaviors including practicing regular eating. Eating disorder cognitive distortions are unique in that they center around weight and shape, negative body image and the harmful belief that weight and shape is connected to self worth. Diet culture, family culture, friends and society shape our view of the world related to thinness and beauty standards. These factors combined can distort our view of beauty, self worth and success. Thoughts such as “I’m worth more when I’m thinner” or “I will be more desirable after I lose weight” are damaging to our self esteem. It is indeed easier to exist in a smaller body: you may receive more compliments, your weight loss is reinforced and people treat you differently. But this doesn’t mean your value as person is connected to your body size. You don’t need to subscribe to societal beliefs around weight and shape. CBT-E also focuses on food rules that developed over the years and don’t serve us in any way. Together, we break free from rules and learn to trust our body again.
Addressing Trauma, Depression, and Anxiety in Eating Disorder
Along with CBT-E, some clients may need to address trauma that began around the time of the eating disorder. Some clients also need help managing depression and/or anxiety symptoms along with the eating disorder. Exploring childhood trauma or early messages around body image and dieting can be beneficial to pinpointing the origin of the cognitive distortions. We also focus on early attachment to our caregivers, healing insecure attachment and exploring any grief and loss experienced during childhood.
We also explore depression symptoms such as low self esteem, low motivation and low mood. CBT is also effective in managing depression and anxiety by challenging negative thoughts, creating alternate, more helpful thoughts and changing a person’s mindset. Examining limiting self beliefs is crucial to reframing these beliefs to reflect our current reality. To learn more about CBT-E for eating disorders, check out this study from the National Library of Medicine.
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